According to study results published in JAMA Neurology, bariatric surgery was better than community weight management (CWM) intervention in lowering intracranial pressure (ICP) in women with obesity and idiopathic intracranial hypertension (IIH).
Participants in this randomized clinical trial (ClinicalTrials.gov Identifier: NCT02124486) were recruited from 5 hospitals in the UK between 2014 and 2017. All patients were women (mean age 32.0 years), had active IIH, and had a body mass index of 35 or more.
The women were randomly assigned to either bariatric surgery (n = 33) or a CWM intervention based on a Weight Watchers program (n = 33). The study researchers assessed the change in intracranial pressure from baseline up to 1 year by measuring the opening pressure during lumbar puncture (LP). At the time of diagnosis, the total mean (standard deviation) LP opening pressure was 35.5 (7.0) cm of CSF (CSF).
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At 1 year, a total of 64 women remained in the clinical trial, but 54 women completed the primary endpoint and were included in this final analysis. Compared to the group that received the CWM intervention, those who underwent bariatric surgery had significantly lower intracranial pressure after 1 year (adjusted mean difference, -6.0 cm CSF; 95% CI, -9.5 up to -2.4; P = 0.001) and at 2 years (adjusted mean difference, -8.2; 95% CI, -12.2 to -4.2; P <0.001).
Similar results were reported in the per-protocol analysis: patients who had undergone bariatric surgery had significantly lower intracranial pressure after 1 year (adjusted mean difference, -7.2 cm CSF; 95% CI, -10.6 up to -3.7; P <0.001) and 2 years (adjusted mean difference, -8.7; 95% CI, -12.7 to -4.8; P <0.001).
Participants in the bariatric surgery arm had a lower weight at 1 year (adjusted mean difference, -21.4 kg; 95% CI, -32.1 to -10.7; p <0.001) and 2 years (adjusted mean difference, -26.6 kg; 95%) CI, -37.5 to -15.7 kg; P <0.001). Bariatric surgery had significantly greater improvements in quality of life at 1-year follow-up (adjusted mean difference 7.3; 95% CI 0.2-14.4; p = 0.04) and 2-year follow-up ( adjusted mean difference.) associated, 10.4, 95% CI 3.0-17.9, P = 0.006).
The researchers found that because of the small number of women in this study, they could not choose any type of bariatric procedure over another. The small sample size also prevented the evaluation of patient-centered results.
Despite these limitations, the researchers suggest that the results “can be used to develop recommendations for health strategies and make health policy decisions related to bariatric surgery for those with active IIH”.
Disclosure: Some study authors stated links with biotech, pharmaceutical, and / or device companies. For a full list of the author’s disclosures, see the original reference.
reference
Mollan SP, Mitchell JL, Ottridge RS et al. Effectiveness of bariatric surgery vs. community weight management intervention for the treatment of idiopathic intracranial hypertension: a randomized clinical trial. JAMA Neurol. 2021; 78 (6): 678-686. doi: 10.1001 / jamaneurol.2021.0659
